Summer of Change

When I stepped away from my national role it was full of hope and excitement for the next phase in my life. Children moving on, big 5O, husband retired and starting a new career in conservation.

I was excited for the time I would claim back to spend with those I love

I was excited for the creativity and freedom a new portfolio career would offer

I was proud of what in working with others I had achieved in a career focused on continually improving our NHS.

But the time with one very special loved one, my mum, was not to be. That system I worked so hard to improve failed her, a series of avoidable harms took her too soon. Hers is a story that is played out daily in our system, the frail and elderly inadequately supported to maintain function. The pandemic saw the removal of her falls prevention programme and social isolation that took the last of her physical strength and mobility. She was a catastrophic fall waiting to happen. But she didn’t let it stop her living her life in as full a way as she could. There is a sort of pride that she was out getting her nails done when she fell. Her refusal to just stay home but instead eke out the small pleasures she could in a life that had become smaller by increments.

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Mum was rushed to hospital and fortunate not to be bumped from the trauma list there was an opportunity for a positive outcome, a turning point in support. A series of hospital acquired harms meant that this was not the outcome for mum, and we lost mum on the 16th June. The two months we endured with her before were in many ways a blur, a rollercoaster of hope, frustration and despair.

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For me as a nurse, some would say a mover and shaker in our health system I felt powerless and as I work through Kubler Ross grief cycle I find I am very angry at all those who failed mum and at all the colleagues I would’ve expected support from who failed me. I question a lack of compassion or time for a colleague and what that means about their true commitment to our endless mission to build a safe person-centred care system. I recognise that much of this thinking is perhaps unfair and that over time I will achieve a balance, reach a less impassioned conclusion.

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My mum gave much of her life to the system as a nurse in palliative care. This system faces some seemingly impossible challenges. A nursing workforce shortage of 5.1 million globally leading to a merry go round of staff movement from one country to the next. A move that does not address the real challenge; there are just not enough nurses and other healthcare professionals to go around. Poor pay and working conditions and failing hope and resilience compound this issue. Teamwork lost, care fragmented, miscommunications rife and a fear of making bold brave decisions, having honest conversations with each other and patients and their families are one of the root causes of all the harm events I witnessed, and my mum endured.

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This was further compounded by a lack of 7/7 therapies cover to keep care plans moving at pace, fulfilling that vital role Virginia Henderson described of moving patients/people along the care continuum from dependence to independence, making the most of whatever function they have.

I witnessed a lack of empowered nurses and others working at the top of their licence and a lack of information sharing that led to the classic Swiss cheese effect, harm events. And yet addressing these challenges was core to my mission as CNIO and Director of Digital Clinical Safety for England. Have I not just failed my mum but all those we serve by not getting technology adopted more rapidly in our health and care system?

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The reality is we cannot be there all the time with our patients and so we must harness all the technology available to support and keep them safe. I truly believe that access to timely information and the use of data as clinical decision support, artificial intelligence and robotic process automation can enable us to target care more effectively and be more purposeful and person centred in our time with patients. I know that much of the technology already exists and I am now angry that we are not moving far and fast enough on a deeply personal level.

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The start of my portfolio career as founder of Future Nurse, a consultancy dedicated to rapidly evolving nursing to adopt technology for better care, has been an existential crisis. Have I wasted a lifetime on a system that is no better when I left than when I started? Would I have been better focusing on caring for fewer people well, starting with my own mother, than trying to solve the problems of a broken system?

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This crisis is far from over for me but as we await the outcome of the coroner’s investigation, I move forward not to acceptance but a renewed commitment to doing what I can in this broken system to make it better.

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I will continue to call to action every nurse to push for more for themselves and their patients. To demand that they are equipped with the latest technology that can enable them to have greater visibility of and more information about those in their care. To be curious about these technologies and push the boundaries of nursing practice reshaping it to address the challenges faced daily.

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I will call on those nurses in leadership positions to support nurses to do this and importantly to stop the merry go round of international recruitment and instead focus on growing and retaining nurses, on ensuring all those nonregistered nurses are well trained and well supervised, on building individuals and teams with the courage to speak up, the compassion to care for each other and the creativity to do things differently.

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As a nurse specialist in technology my biggest failure so far has been to get senior leaders to see this not as ‘other’ but as an essential part of all we do and a key part of the solution to the challenges we face. In memory of my mum, I will strive harder than ever before using my independent voice and unique expertise to not only challenge but work with and support leaders to tackle these challenges head on by enabling nurses to operate at the top of their licence, adopting and pushing the development of technology to its fullest potential to augment and target care. This will be the mission of Future Nurse.

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Epilogue: An alternative scenario for mum

In her supported housing she was truly supported. Ambient monitoring detected her declining mobility and falls risks, the remote MDT discussed her case weekly supported by this data and adapted a plan of care accordingly. Staff shortages meant one on one support was a challenge but with the use of remote monitoring mum received one on one physio input twice weekly alongside a weekly trip to a group falls therapy session.

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This intensive support saw her balance improve and she was safer mobilising outside the home. Through the use of wearable monitoring devices her GP noticed the steady decline in her cardiac function that was leading to shortness of breath. Through an interoperable record he shared this information with her cardiac physician who was able to see her swiftly through a remote consultation which saved her a whole day going to hospital and was reducing his waiting list, improving his work life, and reducing the carbon footprint of the hospital. The MDT which included the GP, cardiac physician and community nurses and physios became concerned that the combined risk of deteriorating cardiac function and osteoarthritis further increased mums risk of harm from a fall. They conducted a full remote MDT review to consider how this might be further managed. Subsequently the frailty consultant nurse visited mum to discuss the level of risk and her tolerance to it.

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Mum was adamant she wanted to get out and about as much as possible. Together they shaped a new plan of care adding in additional steps to manage the risk. Mum ultimately had a much greater understanding of the risk and the steps she could take to mitigate it.

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This fiercely independent woman called for help when navigating the step at the nail salon, she didn’t fall and made it to Ireland for her long-anticipated trip to see her family. In my new role I work less hours and I visit mum weekly to go to her favourite garden centre for lunch. I am not so exhausted that I sometimes see these trips as a burden and responsibility. We are both living life to the full.

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